Description

Enterococci are bacteria of the normal intestinal flora of humans. They are also found in the environment.

Enterococci are harmless most of the time. Sometimes, they cause infections that have to be treated with antibiotics.

Enterococci are naturally resistant to many antibiotics. Vancomycin-resistant enterococci, also called VRE, are enterococci that have developed resistance to an antibiotic called vancomycin. This means that vancomycin is not effective for treating an infection caused by this type of enterococci.

VRE infections are mainly seen in healthcare facilities, especially hospitals.

Symptoms

A person can be a VRE carrier without being ill or showing any signs or symptoms of infection. Being a carrier of the bacteria is not a risk for healthy people.

In general, carrier status is detected from a rectal specimen.

In some people, however, VRE can cause urinary tract infections, wound infections or, more rarely, bloodstream infections. If these infections occur, a wound specimen, urine sample or blood sample is collected. Laboratory testing will determine if VRE are causing the illness.

Treatment

A VRE infection is treated with antibiotics other than vancomycin. Laboratory tests will indicate which antibiotic to use. Most patients recover from the infection.

Complications

Depending on the nature of the infection, a VRE infection can lead to serious complications. Some may be life threatening.

Transmission

VRE are spread by contact after touching contaminated hands or surfaces. Surfaces such as the toilet seat, bed sides and door handles may be contaminated.

The risk of a carrier or an infected person transmitting VRE bacteria to their family members, including pregnant women and children, is low if they are healthy.

VRE can remain in the intestines for several weeks, even several months.

Protection and Prevention

Hygiene measures at home

To avoid spreading VRE at home, take the following hygiene measures:

  • Wash your hands often with soap and water or an antiseptic product. This is the simplest and most effective way to protect yourself against VRE. This measure must be applied by both the carrier or infected person and their family members.
  • Frequently clean the room and bathroom with a household cleaning product or disinfectant. Pay special attention to surfaces and objects that are touched frequently by the carrier or infected person: toilet, grab bar, toilet flush handle, door handles, light switches, bedside table and telephone.
  • Wash the carrier’s or infected person’s clothes and bed linen in warm or hot water with household laundry detergent.
  • Dispose of dressings soiled with the carrier’s or infected person’s secretions in a sealed plastic bag and wash your hands afterwards.

If you are receiving home care, make sure care providers take special precautions when treating someone who is a carrier or is infected with VRE. Gloves and a gown may be required to avoid spreading the bacteria to other people.

You will find additional hygiene measures on the Preventing Transmission of Viruses and Bacteria page.

Measures put in place in healthcare facilities

If you are having a consultation in a healthcare institution, tell the healthcare staff that you or the person with you is a carrier or is infected with VRE.

When a hospital admits a person who is a carrier or is infected with VRE, various measures must be put in place:

  • Isolate the carrier or infected person in a private room or in a room with other patients who are carriers or are infected with VRE, depending on the healthcare setting and the patient’s condition.
  • Clean and disinfect the carrier’s or infected person's room and bathroom frequently.
  • Require gloves and long-sleeved gowns for staff and visitors, depending on the situation.
  • Post a sign on the door of the carrier’s or infected person’s room to remind staff members and visitors to wash their hands and follow the measures put in place.

These measures are maintained until laboratory test results show that the patient is no longer a carrier or infected with the bacteria.

In nursing homes, measures are adapted to the setting and the person's condition.

When it is time for a person who has been treated for a VRE infection to return home, they will be given a list of measures to take to avoid spreading the illness. The doctor or health professional may suggest additional measures if another person at home is ill or has a weakened immune system.

People at Risk

The risk of healthy people developing an enterococcal infection is low.

VRE infections most commonly affect:

  • people who have a weakened immune system;
  • people who need, for example, an intravenous or urinary catheter;
  • people who have wounds;
  • people who have recently been treated with antibiotics for another infection.

Special Conditions

Since 2007, surveillance of VRE cases (carriers and infected people) has been mandatory in Québec hospitals. The surveillance program was established by the Ministère de la Santé et des Services sociaux and is part of the Provincial program for the surveillance of healthcare-associated infections. Healthcare-associated infections are infections acquired during an episode of care provided by a professional in the healthcare network, irrespective of the institution in which the care was provided

In addition, VRE outbreaks in healthcare institutions in Québec must be reported to the public health authorities.